<? global $lg, $FullUrl; ?>

<div class="form-main napthe">
  <div class="form-header">&nbsp;</div>
  <div class="form-content">
    <div style="padding:0 25px; display:block; overflow:hidden;">
      <div class="title-form"><span>Nạp thẻ</span></div>
      <form id="myForm" name="myForm" method="post" action="<?=$FullUrl?>/index.php?do=player&act=napthesm" style="padding-top:30px;padding-left:10px;width:390px; display:block; float:left;" onsubmit="return validateForm()" name="napthe">
      <label style="width:140px !important;">Mã thẻ (phần cào)</label>
      <input type="text" name="pin" id="pin" />
      <br/>
      <label style="width:140px !important;">Số Seri :</label>
      <input type="text" name="serial" id="serial" />
      <br/>
      <label style="width:140px !important;">Nhà cung cấp:</label>
      <select name = "provider" style="margin-left:10px;margin-top:5px;">
        <option value="VNP" selected>Vinaphone</option>
        <option value="VMS">Mobifone</option>
        <option value="VTT">Viettel</option>
        <!--<option value="VTC">VTC Vcoin</option>-->
      </select>
      <br/>
      <!--<label style="width:140px !important;">Server Game:</label>
      <select name = "server">
        <option value="s0" selected>Chọn Server</option>
        <option value="s1" >Thiên Mệnh</option>
        <option value="s2">Nam Vương</option>
      </select>-->
      <?
        	$_SESSION['captcha'] = mt_rand(10000, 99999);
        ?>
      <div style="display:inline-block; margin-left: 150px; width: 150px;"> <img src="lib/Captcha/PHP-CAPTCHA/php_captcha.php"></div>
      <label style="width:140px !important;">Mã kiểm tra:</label>
      <input type="text" name="number_captcha" id="code" value="" onfocus="if(this.value=='Mã kiểm tra') this.value=''" onblur="if(this.value=='') this.value='Mã kiểm tra'" value="Mã kiểm tra"/>
      <br/>
      <!--<input type="hidden" name ="charge1" value="sac"/>-->
      <input type="submit"   value="Nạp thẻ" class="btn-form sbm" />
      </form>
    </div>
  </div>
  <div class="form-bottom">&nbsp;</div>
</div>
<?php Template::UserControlTPL('Menu-GD'); ?>